Texas Medicare Guide

Get personalized Medicare advice from an advisor who cares! Schedule a free consultation with one of our licensed Texas Medicare Advisors or give us a call at (888) 604-0055.

This Texas Medicare guide will walk you through the basics of Medicare to make an informed decision about your health insurance.

Use this table of contents to jump to specific sections:

• A Snapshot of Medicare in Texas
• Eligibility and Enrollment Steps
• Texas Medicare Advantage Plans
• Texas Medicare Supplement Plans Texas Medicare
• Texas Part D Plans
• Get help paying for Medicare in Texas

A Snapshot of Medicare in Texas

There are 4.4 million Texas Medicare beneficiaries, making up 15% of the state’s total population. 17% of Medicare enrollees also receive Medicaid benefits. Medicare beneficiaries have options and can either stay on Original Medicare or switch to a Medicare Advantage plan. In Texas, 54% choose to remain on Original Medicare and 46% enroll in a Medicare Advantage plan.

Texas Medicare Eligibility and Enrollment Steps

All US citizens have the same Medicare eligibility requirements. If you’re 65 or older, you’re eligible. You also may be eligible if you have certain disabilities, including ALS and End-Stage Kidney Disease.

Medicare Enrollment Steps

1. Enroll in Original Medicare (Part A & Part B)

The first thing you need to do is enroll in Parts A & B. If you’re aging into Medicare, you can enroll as soon as three months before the month you turn 65, at the start of your Initial Enrollment Period (IEP). Your IEP is unique to your birth month. It starts three months before the month you turn 65 and ends three months after it. If you choose to delay your Part B enrollment because you’re still working, just be sure you meet the criteria for a Special Enrollment Period once you stop working to avoid paying a penalty.

2. Compare additional coverage options

We mentioned that Medicare beneficiaries have options—the main one being between Medicare Advantage and Original Medicare. Those who choose to stay on Original Medicare also have the option to add supplemental coverage through a Medicare Supplement (Medigap) plan and/or a stand-alone Medicare Part D (prescription drug) plan.

We specialize in helping people understand their Medicare options and pick the best coverage for their needs. Schedule a free consultation with a licensed Texas Medicare Advisor or call us at (888) 604-0055 to get personalized advice!

3. Get the most value from Medicare

Once you’ve made your decisions, it’s time to use your plan! Schedule preventive appointments, like your annual Medicare wellness visit, and be sure to share your new drug plan info with your pharmacy to save on prescriptions.

Each year, during the Medicare Open Enrollment Period, which lasts from October 15 - December 7, make sure to review your coverage to ensure it’s still providing you with the best value. Medicare Advantage and Part D plans can change—and your healthcare needs may change too! While your current plan may still be the best for you, in some cases, changing plans can save people thousands!

Texas Medicare Advantage Plans

There are 263 Medicare Advantage plans in Texas, but availability varies based on the county you live in. For example, Harris County has 77 Medicare Advantage plans from 15 different insurance carriers. Travis County has 46 plans from ten insurance carriers.

Medicare Advantage plans provide an alternative to Original Medicare. They are legally required to provide at least the same amount of coverage as Original Medicare, but generally provide more. Most plans offer Part D benefits, eliminating the need for a stand-alone Part D plan. They also generally cover dental, hearing, and vision services. Finally, they tack on a variety of other benefits, which may include telehealth, fitness perks, flex cards, and transportation to doctor appointments.

Medicare Advantage plans offer more coverage and benefits, and many charge low or $0 premiums. Of course, there are drawbacks that come with Medicare Advantage plans too. In order to provide more coverage at no (or a low) additional cost, they implement network restrictions, often require prior authorizations, and have higher out-of-pocket costs when compared to coverage from Original Medicare with a Medicare Supplement plan.

Texas Medicare Supplement Plans

Original Medicare doesn’t cover about 20% of costs, but you can add a Medicare Supplement (Medigap) plan to help cover the 20%. Texas Medicare beneficiaries have ten Medigap plans to choose from, labeled by letters A through N. These plans cover things like coinsurance, copayments, and deductibles. Each one’s a little different, but the most comprehensive plan (Medigap Plan G) covers pretty much everything but your Part B deductible. This means that, if you’re on a Plan G, once you meet the Part B deductible ($226 in 2023), you don’t owe a penny more for covered services.

Compared to Medicare Advantage plans, Medigap has some big benefits that improve your access to care:

• You can see any doctor who accepts Medicare (90% of doctors nationwide)
• You won’t need to get prior authorization for covered services
• Your out-of-pocket costs are much lower

When you enroll in a Medigap plan matters! During the first six months that you have Part B coverage, you are guaranteed acceptance into any Medigap plan from any insurance company. This is called your Medigap Open Enrollment Period. Outside of this time (and a handful of other guaranteed issue periods with specific criteria), insurance companies are allowed to ask you questions about your health history and may charge you more or deny your application.

Learn more about Texas Medicare Supplement plans.

Texas Part D Plans

Most Medicare Advantage plans come with prescription coverage, but Original Medicare does not. For those who need it, Medicare has stand-alone Part D (prescription drug) plans. There are 27 stand-alone drug plans in Texas. Like with Medicare Advantage, plan pricing and availability is dependent on your county.

Some people don’t need prescription coverage when they first enroll in Medicare. Even if you don't, we recommend enrolling in a low-cost Part D plan to avoid paying a penalty later on!

If you have questions about Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed Texas Medicare Advisors or give us a call at (888) 604-0055.

Get help paying for Medicare in Texas

There are three government programs that can help Texas Medicare beneficiaries with low incomes and resources pay for medical expenses.

Texas Medicaid for Medicare Beneficiaries

The Texas Medicaid programs are run by Texas Health and Human Services.

Texas Medicaid has a few programs and resources for seniors, including:

• Aging and Disability Resource Centers help seniors and individuals with disabilities find long-term care programs.
• Area Agencies on Aging will help find services for residents who are 60 years or older, as well as their family members and caregivers.
• Medicaid for the Elderly and People with Disabilities provides health coverage for older adults and individuals with disabilities who don’t have health insurance.
• Texas Medicare Savings Programs help qualifying individuals with financial support to pay their Medicare premiums, copayments, and deductibles. Benefits vary depending on which of the four programs you’re eligible for.

Learn more about Texas Medicaid programs for seniors here.

Medicare Extra Help

Extra Help is a federal program that helps pay for costs associated with prescription drug coverage, including premiums, deductibles, and coinsurance. It’s also commonly called the Part D Low-Income Subsidy (LIS).

You automatically qualify for Extra Help if you:

• Receive full Medicaid coverage from Texas
• Texas pays your Part B premium
• Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify learn more about Extra Help here or talk to one of our licensed Texas Medicare Advisors to get free support with your application.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

• You are 65 and older, blind, or have a disability
• You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.